Perioperative Calcium Monitoring in Minimally Invasive Radio-Guided Parathyroidectomy: Early Detection and Management of Hypocalcemia

Background: The gold-standard treatment for primary hyperparathyroidism is Minimally invasive radio-guided para thyroidectomy (MIRP). It offers advantages such as minimal invasiveness and faster recovery. However, the incidence of postoperative hypocalcemia following MIRP remains inadequately explored, with existing guidelines on calcium level monitoring lacking clarity. Hypocalcemia, characterized by low serum calcium levels, can be transient, temporary, or permanent, resulting from surgical manipulation or hungry bone syndrome. Objective: To investigate the incidence of transient hypocalcemia following minimally invasive radio-guided parathyroidectomy (MIRP) and to develop a structured protocol for postoperative calcium monitoring and management. Methodology: This retrospective observational study analyzed 48 MIRP cases performed from January to November 2023 to determine the incidence of transient hypocalcemia. Data were collected on postoperative calcium levels, supplementation, and follow-up outcomes, with subgroup analysis comparing same-day discharge and overnight admission patients. Results: 48 patients were analyzed, including 46 MIRP and 2 redo MIRP cases. Of these, 18 patients were admitted overnight. These 30 patients were discharged on a similar day. All patients got prophylactic supplements of calcium for two weeks postoperatively, with follow-up calcium levels measured on day six. Symptomatic hypocalcemia was 2.1% (one patient), managed effectively with increased calcium supplementation. Conclusion: The findings indicate that the risk of hypocalcemia following MIRP is low. Routine postoperative calcium investigations for same-day discharge patients can be safely omitted when calcium supplementation is provided, with follow-up monitoring ensuring safety. This study supports the adoption of outpatient MIRP with structured postoperative protocols, optimizing patient care and healthcare resources. Keywords: Minimally invasive radio-guided parathyroidectomy (MIRP), primary hyperparathyroidism, hypocalcemia, protocol, hungry bone syndrome